单纯玻璃体腔注射雷珠单抗及其联合其他方法治疗3期以上Coats病的疗效观察  

Intravitreal injection of ranibizumab and combined treatment for severe Coats disease

作　　者：杨琼[1] 魏文斌[1] 刘月明[1] 杨丽红[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科研究所北京市眼科学与视觉科学重点实验室,100730

出　　处：《中华眼底病杂志》2014年第5期462-465,共4页Chinese Journal of Ocular Fundus Diseases

基　　金：基金项目：国家自然科学基金（81272981）;北京市自然科学基金（7112031）;北京市卫生系统高层次卫生技术人才培养计划（2009-3-32）

摘　　要：目的 观察单纯玻璃体腔注射雷珠单抗（IVR）及其联合其他方法治疗3期以上Coats病的疗效.方法 回顾性、非对照性临床研究.临床检查确诊为Coats病的19例患者19只眼纳入研究.其中,男性17例,女性2例.年龄1～42岁,平均年龄（13.05±6.78）岁.年龄≤14岁的儿童患者15例;年龄≥18岁的成人患者4例.3a期13例,3b期6例.根据患者视网膜脱离范围及高度、视网膜周边异常血管活性,是否合并眼内增生等不同病变情况,分别行单纯IVR、IVR联合视网膜冷冻、IVR联合视网膜冷冻及视网膜下液引流、IVR联合玻璃体手术治疗.玻璃体腔注药后第1天、第1周及第1个月,根据患者病情变化情况重复治疗.两次治疗的间隔时间≥1个月.其中,1次治疗11例,占57.9％;2次治疗3例,占15.8％;3次治疗3例,占15.8％;4次治疗2例,占10.5％.单纯IVR治疗22次,IVR联合视网膜冷冻治疗6次,IVR联合视网膜冷冻及视网膜下液引流治疗5次,IVR联合玻璃体手术治疗1次.治疗后随访6～36个月,平均随访时间（19.11±7.05）个月.观察患者视力、视网膜复位及并发症发生情况.结果 19例患者中,视力提高2例,占10.5％;视力无变化13例,占68.4％;视力下降1例,占5.3％;因年幼无法配合检查3例,占15.8％.视网膜完全复位3例,占15.8％;部分复位16例,占84.2％.随访过程中出现新生血管性青光眼、玻璃体积血各1例.结论 单纯IVR及其联合其他方法均可有效治疗3期以上的Coats病.Objective To observe the efficacy of intravitreal injection of ranibizumab （IVR） and combined treatment for severe Coats disease.Methods Nineteen Coats disease patients （24 eyes） were enrolled in this retrospective non-comparative interventional clinical study.The patients included 17 males and 2 females.The age was ranged from 1 to 42 years old,with an average of （13.05±6.78） years.The patients included 15 children （age ≤14 years old） and 4 adults （age ≥18 years old）.There were 13 patients with 3a stage and 6 patients with 3b stage.The treatment methods including IVR only,IVR combined with cryotherapy,IVR combined with cryotherapy and sclerotomy to drain subretinal fluid,IVR combined with vitrectomy.Treatments were repeated if it was necessary at the first day,the first week and the first month after injection.The interval between treatments was ≥1 month.Eleven patients （57.9%） underwent one treatment,3 patients （15.8%） underwent 2 treatments,3 patients （15.8%） underwent 3 treatments,2 patients （10.5%） underwent 4 treatments.The treatment frequency including 22 times of IVR only,6 times of IVR combined with cryotherapy,5 times of IVR combined with cryotherapy and sclerotomy to drain subretinal fluid,1 time of IVR combined with vitrectomy.The follow-up period was ranged from 6 to 36months,with an average of （19.11±7.05） months.Visual acuity,retinal reattachment and ocular adverse events were observed.Results Three children （15.8%） were failing to test the visual acuity.Visual acuity was improved in 2 patients （10.5%）,stable in 13 patients （68.4%） and decreased in 1 patient （5.3%）.Three patients （15.8%） achieved totally retinal reattachment after treatment,while 16 patients （84.2 %）achieved partially retinal reattachment.One patient had vitreous hemorrhage.One patient had neovascular glaucoma.Conclusion IVR and combined treatment were effective for severe Coats disease.

关 键 词：视网膜毛细血管扩张症/治疗 血管生成抑制剂/治疗应用 抗体 单克隆/治疗应用 

分 类 号：R774.1[医药卫生—眼科]